Control and outcomes of both types 1 and 2 diabetes may be improved by patients using home glucose meters to regularly measure their glucose levels. Glucose monitoring is both expensive (largely due to the cost of the consumable test strips) and requires significant commitment on the part of the patient. The effort and expense may be worthwhile for patients when they use the values to sensibly adjust food, exercise, and oral medications or insulin. These adjustments are generally made by the patients themselves following training by a clinician.
Formal recommendations on how to reverse type 2 diabetes in clinical practice must await further studies. In the meantime, it will be helpful for all individuals with newly diagnosed type 2 diabetes to know that they have a metabolic syndrome that is reversible. They should know that if it is not reversed, the consequences for future health and cost of life insurance are dire, although these serious adverse effects must be balanced against the difficulties and privations associated with a substantial and sustained change in eating patterns. For many people, this may prove to be too high a price to pay, but for those who are strongly motivated to escape from type 2 diabetes, the new understanding gives clear direction. Physicians need to accept that long-term weight loss is achievable for a worthwhile proportion of patients (96). In the United States, diabetes costs $174 billion annually (97), and in the United Kingdom, it accounts for 10% of National Health Service expenditure. Even if only a small proportion of patients with type 2 diabetes return to normal glucose control, the savings in disease burden and economic cost will be enormous.
Insulin therapy requires close monitoring and a great deal of patient education, as improper administration is quite dangerous. For example, when food intake is reduced, less insulin is required. A previously satisfactory dosing may be too much if less food is consumed causing a hypoglycemic reaction if not intelligently adjusted. Exercise decreases insulin requirements as exercise increases glucose uptake by body cells whose glucose uptake is controlled by insulin, and vice versa. In addition, there are several types of insulin with varying times of onset and duration of action.
If you have type 1 diabetes, your pancreas no longer makes the insulin your body needs to use blood sugar for energy. You will need insulin in the form of injections or through use of a continuous pump. Learning to give injections to yourself or to your infant or child may at first seem the most daunting part of managing diabetes, but it is much easier that you think.
If you have type 2 diabetes and your body mass index (BMI) is greater than 35, you may be a candidate for weight-loss surgery (bariatric surgery). Blood sugar levels return to normal in 55 to 95 percent of people with diabetes, depending on the procedure performed. Surgeries that bypass a portion of the small intestine have more of an effect on blood sugar levels than do other weight-loss surgeries.
I’ve done this for years and I do it each time I’m pregnant in place of the glucose test. It is a cheap and easy way to keep insulin levels in check and see how your body responds to certain foods. While I can offer general advice on the amount of carbohydrates that should be consumed, at home glucose monitoring allows you to know exactly what your body will and won’t handle.
Use of a "Diabetes Coach" is becoming an increasingly popular way to manage diabetes. A Diabetes Coach is usually a Certified diabetes educator (CDE) who is trained to help people in all aspects of caring for their diabetes. The CDE can advise the patient on diet, medications, proper use of insulin injections and pumps, exercise, and other ways to manage diabetes while living a healthy and active lifestyle. CDEs can be found locally or by contacting a company which provides personalized diabetes care using CDEs. Diabetes Coaches can speak to a patient on a pay-per-call basis or via a monthly plan.
“Our findings suggest that even if you have had type 2 diabetes for six years, putting the disease into remission is feasible”, says Prof Michael Lean from the University of Glasgow who co-led the study. “In contrast to other approaches, we focus on the need for long-term maintenance of weight loss through diet and exercise and encourage flexibility to optimise individual results.”
Dr. King said that even short-term remission would reduce or put off some of the serious complications associated with diabetes, like nerve damage, kidney damage, loss of vision, heart attacks and strokes. Yet structured weight loss programs are expensive and often not covered by insurance, and physicians — who are often not well-versed in nutrition — may not take the time to counsel patients about diet, Dr. King said.
To this end, treatment programs such as the Cognitive Behavioural Therapy - Adherence and Depression program (CBT-AD) have been developed to target the psychological mechanisms underpinning adherence. By working on increasing motivation and challenging maladaptive illness perceptions, programs such as CBT-AD aim to enhance self-efficacy and improve diabetes-related distress and one's overall quality of life.
The twin cycle hypothesis of the etiology of type 2 diabetes. During long-term intake of more calories than are expended each day, any excess carbohydrate must undergo de novo lipogenesis, which particularly promotes fat accumulation in the liver. Because insulin stimulates de novo lipogenesis, individuals with a degree of insulin resistance (determined by family or lifestyle factors) will accumulate liver fat more readily than others because of higher plasma insulin levels. In turn, the increased liver fat will cause relative resistance to insulin suppression of hepatic glucose production. Over many years, a modest increase in fasting plasma glucose level will stimulate increased basal insulin secretion rates to maintain euglycemia. The consequent hyperinsulinemia will further increase the conversion of excess calories to liver fat. A cycle of hyperinsulinemia and blunted suppression of hepatic glucose production becomes established. Fatty liver leads to increased export of VLDL triacylglycerol (85), which will increase fat delivery to all tissues, including the islets. This process is further stimulated by elevated plasma glucose levels (85). Excess fatty acid availability in the pancreatic islet would be expected to impair the acute insulin secretion in response to ingested food, and at a certain level of fatty acid exposure, postprandial hyperglycemia will supervene. The hyperglycemia will further increase insulin secretion rates, with consequent enhancement of hepatic lipogenesis, spinning the liver cycle faster and driving the pancreas cycle. Eventually, the fatty acid and glucose inhibitory effects on the islets reach a trigger level that leads to a relatively sudden onset of clinical diabetes. Figure adapted with permission from Taylor (98).
A healthy balance of carbohydrates, proteins, and fats in your diet will help keep your blood glucose on target. How much of each will depend on many factors, including your weight and your personal preferences. Watching your carbohydrates -- knowing how much you need and how many you are eating -- is key to blood sugar control. If you are overweight, either a low-carbohydrate, low-fat/low calorie, or Mediterranean diet may help you get your weight to goal. No more than 7% of your diet should come from saturated fat, and you should try to avoid trans fats altogether.
Suppose your friend is diagnosed with type 2 diabetes, then works hard to lose 50 pounds. He takes himself off all his medications and his blood sugars are now normal. What would you say to him? Probably something like “Great job. You’re really taking care of yourself. Keep it up!” What you wouldn’t say is something like “You’re such a dirty, filthy liar. My doctor says this is a chronic and progressive disease so you must be lying ”. It seems perfectly obvious that diabetes reversed because your friend lost all that weight. And that’s the point. The disease is reversible.
According to the American Diabetes Association, nearly 21 million people in the United States have diabetes, with about 90 percent to 95 percent having type 2 diabetes. Sugar, in the form of glucose, is the main source of fuel for body cells. The hormone insulin allows glucose in the blood to enter cells. In type 2 diabetes, either the body doesn't produce enough insulin or cells are resistant to effects of insulin.
When the weight loss lessens the liver and pancreas fat, the insulin-producing beta cells in the pancreas come to life again. "Almost everyone will return to normal if they lose a substantial amount of weight," Taylor says. "This is a simple disease." What's yet to be figured out, he says, is why the weight loss doesn't lead to a reversal in everyone.
Every single part of the body just starts to rot. This is precisely why type 2 diabetes, unlike virtually any other disease, affects every part of our body. Every organ suffers the long term effects of the excessive sugar load. Your eyes rot — and you go blind. Your kidneys rot — and you need dialysis. You heart rots — and you get heart attacks and heart failure. Your brain rots — and you get Alzheimers disease. Your liver rots — and you get fatty liver disease. Your legs rot — and you get diabetic foot ulcers. Your nerves rot — and you get diabetic neuropathy. No part of your body is spared.
Focus on low glycemic index foods: While reducing fat and increasing fiber can significantly improve insulin sensitivity, low glycemic index (GI) foods reduce after-meal blood glucose levels. Low GI foods include pumpernickel or rye bread, oats, beans, bran cereals, most fruit, and sweet potatoes, compared to higher GI foods such as white potatoes, processed foods, and cold cereals.
But look closer. The results may be statistically significant, but they’re not that impressive compared to medication. Cinnamon lowered A1C by 0.09%, versus the usual 1% with medication. Give A1c reflects overall glucose trends, cinnamon doesn’t look that impressive. Even at the extreme of the confidence interval, cinnamon has, at best, 10% of the efficacy of drug treatments. At worst, it’s completely ineffective.
An injection port has a short tube that you insert into the tissue beneath your skin. On the skin’s surface, an adhesive patch or dressing holds the port in place. You inject insulin through the port with a needle and syringe or an insulin pen. The port stays in place for a few days, and then you replace the port. With an injection port, you no longer puncture your skin for each shot—only when you apply a new port.
Keeping close tabs on your diet is a major way to help manage type 2 diabetes. A healthy diet for people with type 2 diabetes includes fresh or frozen fruit and vegetables, whole grains, beans, lean meats, and low-fat or fat-free dairy. Focus on eating fruit and non-starchy vegetables, like broccoli, carrots, and lettuce, and having smaller portions of starchy foods, meats, and dairy products. Be especially careful about loading up on foods that are high on the glycemic index (GI) and especially the glycemic load (GL), systems that rank foods according to how they affect glucose levels.
A study published in 2014 by the Second University of Naples showed that a low-carbohydrate Mediterranean diet was able to achieve significant rates of remission in people with type 2 diabetes. After one year of following the diet, 15% of participants achieved remission and, after six years, 5% had achieved remission on the diet – a stunning achievement.
Chinese medicine has been using cinnamon for medicinal purposes for hundreds of years. It has been the subject of numerous studies to determine its effect on blood glucose levels. A 2011 study has shown that cinnamon, in whole form or extract, helps lower fasting blood glucose levels. More studies are being done, but cinnamon is showing promise for helping to treat diabetes.
Triglycerides are a common form of fat that we digest. Triglycerides are the main ingredient in animal fats and vegetable oils. Elevated levels of triglycerides are a risk factor for heart disease, heart attack, stroke, fatty liver disease, and pancreatitis. Elevated levels of triglycerides are also associated with diseases like diabetes, kidney disease, and medications (for example, diuretics, birth control pills, and beta blockers). Dietary changes, and medication if necessary can help lower triglyceride blood levels.